Patient Participation Group

Name*

FirstLast

Date of Birth*

Address*

Telephone (home)

Telephone (mobile)

Email

PPG Consent

I, hereby grant Maswell Park Patient Participation Group the right to process my personal data (Photograph, full name, tel no, email) for the purpose of promoting the visions and aims of the Maswell Park Patient Participation Group.

NB: The granting of this consent does NOT involve the Maswell Park Patient Participation Group having any access to your Medical Records held by Maswell Park Health Centre or at any other location by the NHS.

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Privacy*

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